Embedding lived experience into mental health academic research organizations: Critical reflections

Background: As part of a growing emphasis on engaging people with lived experience of mental health conditios in mental health research, there are increasing calls to consider and embed lived experience throughout academic research institutes. This extends beyond the engagement of lay patients andalso considers the potential roles of academic researchers with lived experience. When the lived experience of academic researchers is applied to academic work, there is the potential to improve the relevance of the research, while destigmatizing mental illness within academia. However, there are different and often contrasting perspectives on the way a lived experience academic researcher initiative should be implemented. Objectives: This article describes some of the key issues to be considered when planning an initiative that leverages and values the lived experience of academic researchers, including the advantages and disadvantages of each potential approach. Discussion & Recommendations: Institutions are encouraged to reflect on the ways that they might support and value lived experience among academic researchers. In developing any such initiative, institutions are encouraged to be transparent about their objectives and values, undertake a careful planning process, involve researchers with lived experience from the outsetand consistently challenge the stigma experienced by academic researchers with lived experience. Patient or Public Contribution: Multiple authors are academic researchers with lived experience of mental health conditions

The Sensory and Perceptual Scaffolding of Absorption, Inner Speech, and Self in Psychosis

This study examines the interconnectedness between absorption, inner speech, self, and psychopathology. Absorption involves an intense focus and immersion in mental imagery, sensory/perceptual stimuli, or vivid imagination that involves decreased self-awareness and alterations in consciousness. In psychosis, the dissolution and permeability in the demarcation between self and one's sensory experiences and perceptions, and also between self-other and/or inter-object boundaries alter one's sense of self. Thus, as the individual integrates these changes new "meaning making" or understanding evolves as part of an ongoing inner dialogue and dialogue with others. This study consisted of 117 participants: 81 participants with psychosis and 36 controls. We first conducted a bivariate correlation to elucidate the relationship between absorption and inner speech. We next conducted hierarchical multiple regressions to examine the effect of absorption and inner speech to predict psychopathology. Lastly, we conducted a network analysis and applied extended Bayesian Information Criterion to select the best model. We showed that in both the control and psychosis group dialogic and emotional/motivational types of inner speech were strongly associated with absorption subscales, apart from the aesthetic subscale in the control group which was not significant, while in psychosis, condensed inner speech was uniquely associated with increased imaginative involvement. In psychosis, we also demonstrated that altered consciousness, dialogic, and emotional/motivational inner speech all predicted positive symptoms. In terms of network associations, imaginative involvement was the most central, influential, and most highly predictive node in the model from which all other nodes related to inner speech and psychopathology are connected. This study shows a strong interrelatedness between absorption, inner speech and psychosis thus identifying potentially fertile ground for future research and directions, particularly in the exploration into the underlying construct of imaginative involvement in psychotic symptoms

Experiencing and treating ‘madness’ in the United States circa 1967–2022: Critical counter-histories

Over the past 55 years, in the United States, we have witnessed shifts and changes in mental health treatment practice and policy focused on ‘psychosis.’ Alarmingly, in this same period, neither in its social location nor its clinical outcomes, has psychosis, particularly multi-episode psychosis, shown much substantive improvement (Hansen et al., 2022; Huxley et al., 2021). Epidemiological studies of stigma have documented the worsening of perceived dangerousness and desired social distance (Pescosolido et al., 2010, 2019), while long-term trajectories include extraordinarily high rates of incarceration, homelessness, and unemployment (Lin et al., 2022; Ramsay et al., 2012; Wildeman and Wang, 2017). Disengagement from “services” viewed by users as unresponsive to the user's actual needs and values is thought to be part of the problem, although it is not clear that those who do engage do better (Hansen et al., 2022). Written from the first-person perspectives of current/former “users”—people who have experienced psychosis and “used” services—this paper leverages critical counter-history, conceptual analysis, and autoethnography to ask how and why treatment policies and practices continue to fail so many persons labelled with psychosis in the United States. Outcome, we argue, hangs on much more than clinical effort. We thus explain widespread “treatment failure” as a consequence of interpersonal misunderstanding and misrecognition as well as entrenched structural and institutional ableism, racism, and classism—factors to which clinical services and individualizing narratives alike consistently fail to adequately respond. On a more hopeful note, we trace histories of activist (user/survivor) resistance. This includes efforts that may appear fledgling or transient, but that have nevertheless sustained a distinctly different vision of what might be possible

The Absence of Psychiatric C/S/X Perspectives in Academic Discourse: Consequences and Implications

There is growing recognition that psychiatric consumer, survivor or ex-patient perspectives are not well-integrated into disability studies work and academic discourse more generally. While limited debate has focused on whether the preferred next step is an independent ‘mad studies’ discourse or a disability studies framework more inclusive of c/s/x voices, the broader consequences of this absence have been largely overlooked. The purpose of this review is to highlight three major consequences of the absence of c/s/x voices in US academics: The (1) relatively greater biomedicalization and (2) clinical professionalization of psychiatric disability compared with other forms of disability, and (3) barriers and obstacles to training and advancement in academia for doctoral students and faculty with psychiatric disabilities.Keywords: consumer/survivor movement, disability studies, activist scholarship, disability in higher educatio

Unpacking racial disparities in the involuntary psychiatric commitment of youth and young adults in Allegheny County

An Allegheny County Department of Health report published in 2015 first documented pronounced racial disparities in the involuntary psychiatric commitment (IPC) of youth and young adults in Allegheny County–specifically, Black youth and young adults (YYA) are approximately 2.5 times as likely to experience an involuntary commitment as white YYA. Current county data suggest that disparities have only increased in the years since 2015. Despite the fact that potential harms of IPC are well-documented in the broader literature, IPC in YYA reaming poorly documented and understood, and to our knowledge there have been no subsequent studies addressing racial disparities in any age group. This Momentum Priming Award application proposes a mixed methods pilot study of racial disparities in IPC in YYA in Allegheny county. We will use comprehensive county administrative data available to us under a current DUA that documents IPCs and subsequent mental health services in order to model cross sectional and longitudinal correlates of disparities in YYA involuntary commitments and we will enhance our understanding of the experience of IPV by conducting in-depth interviews with a purposive sample of Black and white YYAs who have experienced IPC and their families